The appendix was ligated by means of a transfixive stitch at the base with a 2/0 absorbable suture and the specimen was then cut and extracted by using the finger of a powder-free surgical glove in order to prevent any contamination of the peritoneal cavity or the surgical wound by the infected specimen. Finally, a purse-string suture was placed on the caecum to invaginate the appendicular stump and the cavity was then gently irrigated with at least 2 liters of warm (38°C) normal saline solution and aspirated, focusing on the right iliac fossa, Douglas pouch, the right flank and perihepatic

beta-catenin inhibitor space. In case of widespread inflammation, a penrose drain was placed on the right iliac fossa according to the surgeon’s criterion. Trocars were then removed, the umbilical hole was closed by means of a 1 Ti-Cron® suture (Covidien Wound Closure) and the skin was sutured with surgical staples. OA requires the same preparation and prophylaxis. The incision may vary depending on the surgeon’s criteria and the characteristics of the patient (Mc Burney, Rockey-Davis or right para-rectal incision). Mesoappendix was ligated by means of a 2/0 silk and a purse-string suture of the same material was placed on the caecum to invaginate the appendicular stump. Lavage with warm saline solution and surgical sponges was performed as deep as the incision would allow. Lavage of the wound

with saline solution was carried out followed by skin closure by means of surgical staples. All data regarding length of hospital stay, morbidity, need for re-consultation in the emergency department after Sepantronium hospital discharge and hospital re-admission were recorded. Patients were classified into four groups according to the type of AA: catarrhalis-phlegmonous appendicitis(FA), gangrenous appendicitis(GA), appendicular plastron with or without localized abscess much (PA) and diffuse appendicular peritonitis (DP). Each group was divided into LA and OA subgroups. Surgical wound infection was defined when a positive culture or purulent discharge was detected or when the wound presented pain or tenderness, localized swelling, redness, or heat, and the incision was deliberately

probed by the surgeon resulting in a positive wound culture. Surgical time was measured from the moment of the skin incision until the closure of the skin. The costs were calculated based on disposable material (Table 1) and hospital stay costs were calculated by means of the center’s clinical information program (“Discharges”), which calculates the cost for the length of stay (LOS), in accordance with the tax regulations of the Valencian regional government, regarding fees for public services based on the DRG and LOS [16]. Table 1 Cost of the material used in OA and LA OPEN APPENDECTOMY Nr. UNITS TOTAL 2/0 silk suture 3 0.4 € 2/0 braided absorbable suture 2 4.3 € Suction device 1 2.3 € TOTAL   7 € LAPAROSCOPIC APPENDECTOMY     Hasson Trocar 1 37 € 5 mm Trocar 2 70 € Endoclinch 1 75 € Lap.